the details

So, I’ve been processing all the details of my consult with my doctor. Of course, additional questions have come to mind since the consult. I think many will be answered when we have our appointment with the IVF nurse.

1) My cervix. Honestly, transfer is probably one of my biggest concerns. He seemed to think that my fears were valid. And I honestly think it’s one of his. He’s never had a transfer where he couldn’t get through a cervix, but he said there have been some where he was “sweating bullets” and thinking that he might have to perform a laparoscopy. He said during the trial transfer, he’ll attempt different catheters, use ultrasound, etc. If it’s really difficult, he’ll probably dilate my cervix between retrieval and transfer – probably with a laminaria. He’ll absolutely use u/s guidance during the real thing. I asked about sedation – he’s never done that before, but said that we could consider it.

2) OHSS. Due to my responsiveness thus far, it’s a concern. I’m going to try not to worry about it too much, but we discussed that the odds for me to seriously overstimulate are higher than the standard 1%. If it appears I am in danger of severe OHSS, we will freeze all the embryos and do a FET later.

3) Protocol. It will be the standard “long” or “overlap” protocol. Birth control pills overlapped with lupron, then cut the lupron back while beginning stims. I don’t have my personal calendar yet, but the stim drug will be Gonal-F.

4) Follicles. He said that, in his experience, women like me do one of two things. 1) Have many “synchronous” (I like that word) follicles and he ends up retrieving a lot of eggs – like 20. 2) Have 3-4 significant lead follicles and he ends up retrieving 7-10 eggs. He says he actually prefers the latter. It’s the “quality, not quantity” argument. If I have 20+ eggs, it’s more likely that I will overstimulate, that the eggs won’t be as “good”, so to speak. He joked that he fully expects tears if he retrieves fewer eggs.

5) 3 day vs. 5 day transfer. He believes in 5 day transfers, but only if there are many high quality embryos. If there are fewer embryos, or they are of poorer quality, he believes they do better in the uterus than in the lab. I believe Thalia’s Dr. Candour has a similar approach. So we won’t actually know which we’ll be doing until later.

6) Number of embryos to transfer. If it’s a 3 day transfer, we’ll transfer 2. 5 day transfer, he wants to only transfer 1. I understand why, but it will be hard for me to not want 2.

7) Success rates. Around 65% live birth rate or ongoing pregnancy rate for my age group in 2005. His quote, that I’m hoping he doesn’t have reason to regret later was, “Your chances are spectacular.”

8) Running. J told on me. He told the dr I’d run the 1/2 marathon, and as I expected, he wasn’t thrilled. He said, “None of that marathon stuff while we do IVF.” He asked (again) how much I was typically running. I told him 5 miles, 4 times per week. He said that was on the “outside limit of acceptable.” I told him I would stop or cut back if he told me to. He didn’t. He said he didn’t want that much power, and that he understood why I run. I deeply appreciate that. My plan is to continue where I am now through the bcps and lupron. I will gradually cut back during stims (or stop if I think I need to). I will take a complete break after retrieval.

9) Parents. I’m struggling with how much to tell our parents. Part of me wants them to know and understand; part of me knows that will never happen. I asked him about literature that would be parent friendly (like IVF for Dummies or something). He offered to go to breakfast with both sets of our parents to try to explain everything to them. It’s an offer I’ll never take him up on, even though he seemed completely serious. He repeated the offer more than once.

10) Patients. The clinic will be moving to nice, pretty new buildings in June. They plan to have the embryology lab on site (it’s now at a different location from the clinic) and up and running by August. He said something about me in the new building – I replied, “I’m not planning on knowing you in August.” He said, “I’ll always *know* you. Just not like this.” I said, “OK, I don’t plan on you remembering me come August.” He responded, “Bullsh*t! I always remember my patients. All of them.” It was amusing how defensive he was. He went on to explain how he sees women out in public, and is often disappointed because they don’t really want to talk to him on a social level. It’s hard for me to believe that he remembers all of us.

11) Frozen embryos. The official odds that we will have frozen embryos: 22%. He said that number is inclusive of all age groups, and that he would expect our odds to be somewhat higher than that. Maybe 30-35% or so.

12) ICSI. Probably. J has another semen analysis scheduled for Wednesday. I anticipate the final recommendation will be for ICSI.

Once you’re into the stimming you may not find running comfortable. Walking was uncomfortable, and I don’t mean the workout kind of walking… just normal walking around in my life was unpleasant. But I’m a hyperstimmer, so maybe that’s just me.

I’m so glad you’ve got such a kind and thorough doctor. It must bring some peace.

Once you’re into the stimming you may not find running comfortable. Walking was uncomfortable, and I don’t mean the workout kind of walking… just normal walking around in my life was unpleasant. But I’m a hyperstimmer, so maybe that’s just me.

I’m so glad you’ve got such a kind and thorough doctor. It must bring some peace.